By Dr. Colin Michie FRCPCH University of Central Lancashire.
Most of us, thankfully, are unlikely to become malnourished. However, some become anaemic and are found to have a vitamin D deficiency for no obvious reason. This can be the result of coeliac disease.
Coeliac disease was thought to be a problem of white folk. However, recent surveys have found large numbers of undiagnosed cases in populations of other ethnicities. Coeliac disease is probably present in approximately 1% of most humans, and the challenge is that most patients with coeliac disease do not know they have this diagnosis.
Coeliac disease is a life-long disorder of the immune system that starts in the gut. It can affect many other parts of the body. Most times, our tripes quietly digest our food; but in coeliac disease, gluten in the diet inflames them and causes malfunction. In coeliac disease, the intestine does not absorb nutrients well – this is malabsorption. In children, this can lead to slow growth. Affected individuals often describe abdominal pains and a loss of appetite; fatigue and a bloated abdomen. There may be loose stool or constipation; there may also be skin rashes, with reddening and blisters in patches. These are all because of gluten in the diet.
Whatever our age, we may have coeliac disease – even if we have few or no symptoms. For instance, some are diagnosed only when they are elderly. It is not clear why this might be. Perhaps, some adapt to the symptoms; some may subconsciously avoid foods containing gluten because they cause abdominal pain. Older patients may have problems related to low levels of iron (anaemia) and vitamin D (muscle and bone weakness), along with a low body mass and a number of possible bowel conditions.
Coeliac disease can have some unusual ways of presenting too. As examples, it is linked to problems with the tongue, mouth lining, tooth enamel and dry eyes. It is more frequent in those with psoriasis and vitiligo. It contributes to infertility in men and women and, if not treated, can compromise a successful pregnancy. It may cause difficulties with gait; and neurological conditions have been documented too. Coeliac disease itself is more frequent in those with type 1 diabetes and those with immunological thyroid problems.
So what drives this curious condition? Genetic predispositions are required, because only a few specific genetically determined molecules will direct immune systems to react to gluten. It follows that if you have a blood relative who has coeliac disease, you too may suffer with it. You cannot escape the roots of your family tree! If in doubt, ask your doctor for a test!
Gluten is found in the grains of wheat, rye and barley – and wheat, in particular, gets everywhere! From sandwiches to pizza, and even soy sauce or beer, contain gluten. Although wheat is short on flavour, and tastes rather like wallpaper paste, it is particularly useful in creating many food textures that we love – crackers, buns, breads, cakes, wraps, samosas. Convenience foods that we love often contain wheat.
Vast areas of farmland are dedicated to growing this grain. Even in rice-growing areas, it has become increasingly popular as it delivers a large number of food calories per acre. Medical problems linked to gluten have increased with the growing use of wheat in human food chains. Those with the predisposed genetic make-ups will react to it, whether they consume it in an infant food or new snack. They will go on to develop coeliac disease.
A diagnosis of coeliac disease is regrettably rarely considered by doctors and the tests for it are seldom requested. It causes changes in the microscopic appearance of the intestinal lining and it leads to the development of characteristic antibody patterns in the blood and its genetic links can be measured too, even from a finger-prick blood test. Blood collected from population samples identifies many with coeliac disease who are not aware of their condition. Other cases are diagnosed following biopsies collected from an upper bowel by endoscopy.
Treatment for coeliac disease is logical and simple. Remove gluten from one’s diet. Practical information as to whether gluten is present in most manufactured foods should be delivered by food allergen labelling, but assistance from a dietician is valuable. Rice, sorghums, oats, chickpeas, quinoa, buckwheat and teff do not contain gluten – nor do Irish potatoes, sweet potatoes, cassava, yam, dasheen, pulses and nuts, or fruits including ackee. Foods prepared from this list, or those using many Arawak (and “paleo”) recipes are “safe”.
Many who do not have coeliac disease describe themselves as being sensitive to gluten. Unlike coeliac disease, there are no medical tests for these less risky conditions. Thankfully, they do not cause malnutrition. Bowels are not well understood and modern diets may not always agree with them.
Useful resources:
https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease
Dr. Colin Michie is currently the Associate Dean for Research and Knowledge Exchange at the School of Medicine in the University of Central Lancashire. He specialises in paediatrics, nutrition, and immunology. Michie has worked in the UK, southern Africa and Gaza as a paediatrician and educator, and was the associate Academic Dean for the American University of the Caribbean Medical School in St. Maarten a few years ago.
